Provider Demographics
NPI:1780687764
Name:CARLTON, CONNIE GRAY (MAED,MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:GRAY
Last Name:CARLTON
Suffix:
Gender:F
Credentials:MAED,MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:28585-6381
Mailing Address - Country:US
Mailing Address - Phone:252-448-9841
Mailing Address - Fax:252-448-1773
Practice Address - Street 1:208 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NC
Practice Address - Zip Code:28585-6381
Practice Address - Country:US
Practice Address - Phone:252-448-9841
Practice Address - Fax:252-448-1773
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127AWOtherNCBCBS
NC7411658Medicaid